• Faraydoon Hassan Mohammed Board Candidate of Oral and Maxillofacial Medicine, Teaching Hospital, Kurdistan Region, Iraq.
  • Shanaz Mohammed Gaphor College of Dentistry, University of Sulaimani, Kurdistan Region, Iraq.
  • Kosar Mohamad Ali College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.



Asthma, Chronic Obstructive Pulmonary Disease (COPD), Pneumonia, Pulmonary Fibrosis, Candidiasis, Oral Ulceration, Dry Mouth, Oral Hygiene, Oral Lesions



Many Respiratory disorders, such as chronic obstructive pulmonary disease, asthma, and pneumonia, all have clinical and therapeutic involvement of the oral cavity, emphasising the need for routine dental examination and close inspection of the oral cavity, as well as active cooperation between dentists and pulmonologists.


To find the prevalence of oral manifestations of hospitalised patients with respiratory diseases.

Patients and Methods

This cross-sectional study was conducted from October 2019 to March 2020 in an internal medical teaching hospital in Sualimani-Iraq, which included one hundred patients admitted and diagnosed with respiratory diseases. Patients were interviewed regarding oral manifestations of respiratory diseases, and they were subjected to complete oral mucosal examination. In addition, required data were collected through a specially designed questionnaire.


Females were predominant (55%) with a mean age (64.00 ± 14.08) years old. The age groups (51-60) and (61-70) among COPD and Asthmatic patients were more affected by respiratory diseases, with significant sex differences being more in females. (P ˂ 0.001). The most frequent oral manifestation was oral candidiasis (35%), mainly on the palate, mostly in asthmatic and COPD patients. Oral ulceration (12%) primarily on lower labial mucosa and tongue was statistically significant (P ˂0.001) than other sites. Other reported manifestations were gingival enlargement (49%), coated tongue (10 %), geographic tongue (4%), fissured tongue (6%), hairy tongue (3%). The predominant subjective symptom was the feeling of dry mouth (89%); most of the patients (49%) had adequate oral hygiene. 


females and asthma were more reported in hospitalized respiratory diseased patients. Oral candidiasis predominantly on the palate and dry mouth (xerostomia) was the predominant patients’ symptom.


Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. The global burden of oral diseases and risks to oral health. Bull World Health Organ. 2005;83(9):661-9.

Byrappagari D, Alves-Dunkerson J, Chamie C, Peters R. The impact of oral disease on the lives of Washingtonians- the Washington state oral disease burden document. Washington State Department of health. Olympia, WA. July 2007. DOH 160-001

Albert RK, Spiro SG, Jett JR. Comprehensive respiratory medicine. London; Philadelphia: Mosby; 1999. 1st edition.

Cojocaru, Doina-Clementina, Georgescu, Andrei, Negru, Robert D. Oral Manifestations in pulmonary diseases - too often a neglected problem. Int. J. Med. Dent. (2015).117-123.

Raghavendran K, Mylotte JM, Scannapieco FA. Nursing home-associated pneumonia, hospital-acquired pneumonia and ventilator-associated pneumonia: the contribution of dental biofilms and periodontal inflammation. Periodontol 2000. 2007;44:164-77. DOI:

Standards for diagnosing and caring for patients with chronic obstructive pulmonary disease. American Thoracic Society. Am J Respir Crit Care Med. 1995;152(5 Pt 2):S77-121.

Devine JF. Chronic obstructive pulmonary disease: an overview. Am Health Drug Benefits. 2008;1(7):34-42.

SS, Rahman, M.Faruque, MHAKhan, SAHossain. Dental management of COPD patient.Bang Med J (Khulna) 2011; 44 21-24. DOI:

Leuckfeld I, Obregon-Whittle MV, Lund MB, Geiran O, Bjortuft O, Olsen I. Severe chronic obstructive pulmonary disease: association with marginal bone loss in periodontitis. Respir Med. 2008;102(4):488-94. DOI:

Hyman JJ, Reid BC. Cigarette smoking, periodontal disease: and chronic obstructive pulmonary disease. J Periodontol. 2004;75(1):9-15. DOI:

Wang Z, Zhou X, Zhang J, Zhang L, Song Y, Hu FB, et al. Periodontal health, oral health behaviours, and chronic obstructive pulmonary disease. J Clin Periodontol. 2009;36(9):750-5. DOI:

Kornum JB, Svaerke C, Thomsen RW, Lange P, Sorensen HT. Chronic obstructive pulmonary disease and cancer risk: a Danish nationwide cohort study. Respir Med. 2012;106(6):845-52. DOI:

Thomas MS, Parolia A, Kundabala M, Vikram M. Asthma and oral health: a review. Aust Dent J. 2010;55(2):128-33. DOI:

Gani F, Caminati M, Bellavia F, Barroso A, Faccioni P, Pancera P, et al. Oral health in asthmatic patients: a review: Asthma and its therapy may impact on oral health. Clin Mol Allergy. 2020;18(1):22. DOI:

Stensson M, Wendt LK, Koch G, Oldaeus G, Birkhead D. Oral health in preschool children with asthma. Int J Paediatr Dent. 2008;18(4):243-50. DOI:

Li X, Kolltveit KM, Tronstad L, Olsen I. Systemic diseases caused by oral infection. Clin Microbiol Rev. 2000;13(4):547-58. DOI:

Scannapieco FA, Papandonatos GD, Dunford RG. Associations between oral conditions and respiratory disease in a national sample survey population. Ann Periodontol. 1998 Jul; 3(1)251-6. Doi 10.1902a. DOI:

Loesche WJ, Lopatin DE. Interactions between periodontal disease, medical diseases and immunity in the older individual. Periodontol 2000. Feb; 1680-105. Doi 10.1111j.1600-0757.1998.tb00117.x. DOI:

Gribbin J, Hubbard RB, Le Jeune I, Smith CJ, West J, Tata LJ. Incidence and mortality of idiopathic pulmonary fibrosis and sarcoidosis in the UK. Thorax. 2006;61(11):980-5. DOI:

Wuyts WA, Agostini C, Antoniou KM, Bouros D, Chambers RC, Cottin V, et al. The pathogenesis of pulmonary fibrosis: a moving target. Eur Respir J. 2013;41(5):1207-18. DOI:

Segalla G, Iovene B, Calvello M, Ori M, Varone F, Richeldi L. Idiopathic pulmonary fibrosis: pathogenesis and management. Respir Res. 2018;19(1):32. DOI:

Newman MG, Takei HH, Carranza FnA. Carranza's clinical periodontology. 10th ed. St. Louis, Mo.: Saunders/Elsevier; 2006. xxxvi, 1286 p. p.

Greene JC, Vermillion JR. The Simplified Oral Hygiene Index. J Am Dent Assoc. 1964;68:713. DOI:

Adeniyi, Bamidele & Awokola, Babatunde & I, Irabor & Obaseki et al. Pattern of respiratory disease admissions among adults at the federal medical centre, owo, southwest Nigeria a five year-review. Ann M.

Godara N, Godara R, Khullar M. Impact of inhalation therapy on oral health. Lung India. 2011;28(4):272-5. DOI:

Dubus JC, Marguet C, Deschildre A, Mely L, Le Roux P, Brouard J, et al. Local side-effects of inhaled corticosteroids in asthmatic children: influence of the drug, dose, age, and device. Allergy. 2001;56(10):944-8. DOI:

Cheng, T, Li Y, Zhang, H, Chen, L, Tu, J, Hui, X. et al. Incidence of oral candidiasis is associated with inhaled corticosteroids in Chinese patients A systematic review and meta-analysis. 2017;.

Torres SR, Peixoto CB, Caldas DM, Silva EB, Akiti T, Nucci M, et al. Relationship between salivary flow rates and Candida counts in subjects with xerostomia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;93(2):149-54. DOI:

Khaled S, Ayinampudi B, Gannepalli A, Pacha V, Kumar J, Naveed M. Association between oral manifestations and inhaler use in asthmatic and chronic obstructive pulmonary disease patients. Journal of Dr NTR University of Health Sciences. 2016;5(1). DOI:

Ghapanchi J, Rezazadeh F, Kamali F, Rezaee M, Ghodrati M, Amanpour S. Oral manifestations of asthmatic patients. J Pak Med Assoc. 2015;65(11):1226-7.

Azarpazhooh A, Leake JL. A systematic review of the association between respiratory diseases and oral health. J Periodontol. 2006;77(9):1465-82. DOI:

Shashikiran ND, Reddy VV, Raju PK. Effect of antiasthmatic medication on dental disease: dental caries and periodontal disease. J Indian Soc Pedod Prev Dent. 2007;25(2):65-8. DOI:

Dwibedi N, Wiener RC, Findley PA, Shen C, Sambamoorthi U. Asthma, chronic obstructive pulmonary disease, tooth loss, and edentulism among adults in the United States: 2016 Behavioral Risk Factor Surveillance System survey. J Am Dent Assoc. 2020;151(10):735-44 e1. DOI:

Bhavsar NV, Dave BD, Brahmbhatt NA, Parekh R. Periodontal status and oral health behaviour in hospitalised patients with chronic obstructive pulmonary disease. J Nat Sci Biol Med. 2015;6(Suppl 1): S93-7. DOI:

Rastogi T, Chowdhary Z, Krishna MK, Mehrotra S, Mohan R. Prevalence of periodontitis in patients with pulmonary disease: A cross-sectional survey in the industrial district of India. J Indian Soc Periodontol. 2019;23(3):269-74. DOI:



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